Provider First Line Business Practice Location Address:
1620 N MAMER RD STE B100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPOKANE VALLEY
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99216-3712
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-863-9779
Provider Business Practice Location Address Fax Number:
509-863-9608
Provider Enumeration Date:
04/26/2018